The health survey conducted in Cambodia gathered data from 510 households on topics such as water access, sanitation, household health, maternal health, and child health. Some key findings include: - The majority of households rely on unprotected surface water or open wells as their main water source. - Most households treat their water by boiling or letting it settle, but sanitation practices like handwashing are still lacking. - The majority of households have no toilet facility, with open defecation being common. - Common illnesses reported were related to lack of sanitation, nutrition, and mosquitos. Households struggle to access and afford healthcare. - During pregnancy, most women received some antenatal care, though

1. HEALTH REPORT March 2012
CRWRC CAMBODIA
Research by Kimsear Hong and Laurel Koopmans

2. OUTLINE
 SURVEY OVERVIEW
 WATER AND SANITATION
 HOUSEHOLD HEALTH
 MATERNAL HEALTH
 CHILD HEALTH
 PROGRAM PRIORITIES
 CONCLUSION

3. SURVEY OVERVIEW
 QUESTIONNAIRE DEVELOPMENT
Based on UNICEF Multiple Indicator Cluster Survey
510 surveys in a total of 30 cluster sites
 PILOT INTERVIEW
Conducted in Toul Tom Poung I, Phnom Penh on October 20, 2011
 TRAINING AND SURVEY REVISION
Interviewer 3-day training held at CRWRC October 25-27, 2011
 IMPLEMENTATION
November 2011 surveys were conducted at cluster sites
Monitoring done by Survey Core Team and CRWRC Project Officers
 DATA ENTRY
Epi Info TM Version 3.5.3 software available from the Centers for Disease
Control and Prevention. November 29, 2011- January 25, 2012
 DATA ANALYSIS
Epi Info TM Version 3.5.3 February 6-13, 2012

4. CRWRC
Cambodia
PRELIMINARY FINDINGS Health
Survey

5. WATER ACCESS
Table 1 . Main Sources of Water for Drinking and Cooking in Dr y
Season
Main Sources of Water Number Percentage(%)
1 Tube well or borehole 316 62.1
2 Surface water 138 27.1
3 Tanker truck/water vender 22 4.3
4 Unprotected dug well 21 4.1
5 Rain water 6 1.2
6 Protected dug well 3 0.6
7 Piped water into dwelling 2 0.4
8 Piped water into yard or plot 1 0.2
Total 509 100

6. WATER ACCESS
Table 2. Main Sources of Water for Drinking and Cooking in Wet Season
Type of water Number Percentage (%)
1 Rain water 151 89.9
2 Surface water 8 4.8
3 Tube well or borehole 5 3
4 Protected dug well 2 1.2
5 Unprotected dug well 1 0.6
6 Protected Spring 1 0.6
Total 168 100

7. WATER TREATMENT
 79.3% of the inter viewees treated water to make it safer to drink
Table 3. Frequency usage of dif ferent types of water treatment
Types of water treatment Number Percentage of
households(%)
1 Boil 318 62.6%
2 Let it stand and settle 170 33.3%
3 Use water filter (ceramic, etc) 115 22.5%
4 Solar disinfection 15 2.9%
5 Add bleach/Chlorine 5 1.0%
6 Strain through a cloth 5 1.0%
7 Other 12 2.4%

8. WATER ACCESS
NEEDS ASSE T S
 Water testing and quality  RDI, Resource Development
International
 Water treatment
 CAWST, Centre for Af fordable
Water and Sanitation
 Well protection and Technology
maintenance
 RainWater Cambodia
 Alternative water sources
 Water for Cambodia
 Water conservation
 Community Guide to
Environmental Health in
 Water safety awareness Khmer
 IDE Cambodia

9. SANITATION
Table 4. Toilet facility usually used by household
Types of toilet Number Percentage (%)
1 No toilet/field/forest 336 66.1
2 Flush/pour flush to pit latrine 137 27.0
3 Flush/pour flush to septic tank 19 3.7
4 Toilet over water 3 0.6
5 Ventilated improved pit latrine 2 0.4
6 Compost toilet 2 0.4
7 Flush/pour flush elsewhere 1 0.2
8 Flush/pour flush, don’t know where 1 0.2
9 Other 7 1.4
Total 508 100

10. SANITATION
Figure 1. Percentage of households practicing hand-
washing with soap and clean water
24.9% 0% 0%
(Does not
wash hands)
75.1%
(Washes
hands)

11. SANITATION
Table 5. Frequency of hand-washing with soap and clean water for specific occasions
Specific Occasion Number Percentage of
households(%)
1 Before eating a meal 295 57.8%
2 After toilet use 216 42.4%
3 Before cooking 194 38.0%
4 After handling animals 102 20.0%
5 Contact with someone who is sick 26 5.1%
6 Other 32 6.3%

12. SANITATION
NEEDS ASSETS
 Toilet access  CLTS, Community Led
Total Sanitation Guide
 Awareness of impacts
of open defecation  IDE Cambodia-Easy
Latrine
 Maintenance of latrines
 Community Guide to
 Hand-washing practices Environmental Health in
Khmer

13. ANIMAL CARE
NEEDS ASSETS
 Animal waste
management  Community veterinarians
 Increased knowledge of  Some partners have done
animal diseases and basic animal
prevention raising, KADRA
 Animal raising education
 Capacity of veterinarians
living in target
communities

14. HOUSEHOLD HEALTH
 78% of households reported having member(s) of household
sick in the last 30 days
Figure 2. Location household members go to when someone is sick
60.0%
50.4%
50.0%
Percentage of households
40.0%
30.0%
20.0% 18.0%
10.0% 7.5% 6.6%
4.5% 5.5%
3.6%
1.1% 0.4% 0.1% 1.0% 0.1% 0.4% 0.7%
0.0%

15. HOUSEHOLD HEALTH
Most commonly reported causes of illness for members of
household:
 Mosquitos/not sleeping under mosquito net
 Changes in the weather/climate
 No latrine for use
 Eating fresh vegetables
 Lack of food or nutritious foods
 Poor sanitation
 Drinking unboiled water/drinking unclean water
 Drinking alcohol
 Sun exposure
 Physical labour/hard work
 Poor or insufficient care of small children
 Old age

16. HOUSEHOLD HEALTH
Figure 3. Distance to accessed health service
Don't know
More than 20 km
Between 10-20km
Between 5-10km
Between 2-5km
Between 1-2 km
1 km or less
0.0% 5.0% 10.0% 15.0% 20.0% 25.0%
Percentage of households

17. HOUSEHOLD HEALTH
Figure 4. Fees paid on last visit to treatment location.
Don't know
Greater than 40 USD
Between 10-40USD
Between 6-10USD
Between 3-6 USD
Between 1-3 USD
1 USD or less
Free
0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

18. HOUSEHOLD HEALTH
Figure 5. Source of funds households use to pay for treatment.
Other
9% Sell animal
23%
Savings/savings Sell land
group 0%
27%
Borrow from Borrow from Sell personal
neighbor relatives property
12% 19% 10%

19. HOUSEHOLD HEALTH
 44.1% of households have member(s) who smoke
cigarettes
Table 6. Amount of cigarettes smoked daily by household member
Amount of Smoking Number Percentage(%)
1 1-2 sticks per day 19 8.4
2 3-4 sticks per day 37 16.3
3 6-8 sticks per day 23 10.1
4 9-10 sticks per day 36 15.9
5 > 10 sticks per day 98 43.2
6 Don’t know 14 6.2
Total 227 100

20. HOUSEHOLD HEALTH
Table 7. Identified impacts of smoking on health
Types of Impact Number Percentage of
households (%)
1 Cancer 460 90.2%
2 Bad smell 166 32.5%
3 Poor teeth/ oral hygiene 152 29.8%
4 Heart and cardiovascular disease 58 11.4%
5 Stomach problem 50 9.8%
6 Other 60 11.8%

21. HOUSEHOLD HEALTH
76.5% of households have member(s) who drinks alcohol
Table 8. Alcohol consumption by member of household
Amount Number Percentage
1 Rarely 158 40.6
2 Only at ceremonies/celebrations 67 17.2
3 1-2 drinks per week 83 21.3
4 3-6 drinks per week 57 14.7
5 7-10 drinks per week 8 2.1
6 >11 drinks per week 14 3.6
7 Don’t know 2 0.5
Total 389 100

22. HOUSEHOLD HEALTH
Table 9. Identified impacts of alcohol consumption on health
Types of impact % of households
Liver problems 404 79.2%
Cardiovascular issues 44 8.6%
Cancer 89 17.5%
Chronic pancreatis 42 8.2%
Kidney disease 10 2.0%
Diabetes 26 5.1%
Addiction 106 20.8%
Violence 175 34.4%
Other 91 17.8%

23. HOUSEHOLD NUTRITION
Figure 6. Household Diet During Dry Season
1200
Fermented cheese
1000
Eggs
800
Beans
600
Fruit
(mango, pineapple, etc)
400
Other vegetables
200
Green leafy vegetables
0
Everyday 3-6 times a week 1-2 times a week Rarely Never
Frequency of Food Consumed

24. HOUSEHOLD NUTRITION
Figure 7. Household Diet During Wet Season
1200
Fermented cheese
1000
Eggs
800
Beans
600
Fruit
(mango, pineapple, etc)
400
Other vegetables
200
Green leafy vegetables
0
Everyday 3-6 times a week 1-2 times a week Rarely Never
Frequency of Food Consumed

25. HOUSEHOLD HEALTH
NEEDS
 Access to quality public services
 Trained professionals and better distribution of facilities
 Increase trust in health providers by patients
 Preventive health education
 Reduction of exposure to pollutants released in cooking with
biomass and burning of plastics
 Reduction of tobacco use and alcohol consumption
 Safe waste disposal

26. HOUSEHOLD HEALTH
ASSETS
Community Guide to Environmental Health in
Khmer
Smoking cessation curriculum in
Khmer, ADRA Cambodia
Environmental Training

27. FOOD SECURIT Y
Figure 8. Household has worried food would run out before there
was money to buy more
Sales, 0
Never
3%
Often
Sometimes Sometimes
36.6% Often Never
60.4%

28. FOOD SECURIT Y
Figure 9. Household relied on only a few kinds of low-cost food to
feed household because of lack of food or money to buy food.
0%
Often
10%
Never
38% Often
Sometimes
Sometimes Never
52%

29. FOOD SECURIT Y
Figure 10. In the last 12 months, the household cut size of meals or
skipped meals because there wasn't enough money for food.
0%
Often
10%
Never
38% Often
Sometimes
Sometimes Never
52%

30. FOOD SECURIT Y
Figure 11. Number of meals household ate the day prior
to the interview
2.2% 0.2%
40.9%
1 meal
56.7% 2 meals
3 meals
4 meals
(Median number of meals 3)

31. FOOD SECURIT Y
NEEDS ASSETS
 Funding opportunities
 Rice production
 Partner Project, Farmer
 Nutrient intake Field Schools
 Increase in household  Food Resource Bank
gardens
 On-going agricultural
 Income generation training, SRI
 Existing income
generation projects

32. MATERNAL HEALTH
Figure 12. At time of pregnancy mother’s desire for pregnancy
Not at all
14%
Later Then
19%
Later
Then Not at all
67%

33. ANTENATAL CARE
 97% of mothers interviewed indicated they received antenatal
care during their pregnancy
Figure 13. Antenatal care provider for this pregnancy
3% 4% 5%
Doctor/medical assistant
Nurse
Midwife
Traditional birth attendant (TBA)
88%
*Percentages calculated on with total number of responses not the number of households

34. ANTENATAL CARE
Figure 14. Number of months mother was pregnant at time of first antenatal visit for
this pregnancy
250
200
Number of mothers
150
100
50
0
1 2 3 4 5 6 7 8 9 Don't know
Number of months

35. ANTENATAL CARE
Figure 15. Number of times mother received antenatal care for this pregnancy
140
119
120
100
83
Number of mothers
80 75
60
60
50
40 34
30
18
20 14
9
0
1 2 3 4 5 6 7 8 9 Don't know
Number of antenatal care visits during pregnancy

36. MATERNAL HEALTH
Figure 16. Location of delivery
Other public
Private
0.2% Other
clinic
private Other
0.6%
Health post 0.4% 0.2%
0.2%
Home of mother
32.4%
Health center
58.2%
Home of midwife/TBA
2.0%
Provincial hospital
3.7%
District hospital
2.2%

37. MATERNAL HEALTH
NEEDS
 Maternal nutrition
 Family planning
 Follow-up post-partum
 Breastfeeding practices/alternatives
 Maternal Mortality

38. MATERNAL HEALTH
ASSETS
 Nancy TenBroek , CRWRC Regional Health Advisor
 RHAC, Reproductive Health Association of Cambodia
 RACHA, Reproductive and Child Health Alliance
 AVI, Australian Volunteers International (AUSAid)
 Ministry of Health- Midwife Regional Training Centers
 RESOURCE/TRAINING MATERIALS
 CORE Group
 RACHA
 RHAC

39. CHILD BIRTH WEIGHT
Figure 17. Child birth weight
More than 4.0 kg
2%
Less than 1.5 kg
1% Don't know
12%
Between 1.5-2 kg
4%
More than 4.0 kg
Between 3-4 kg
35% Between 3-4 kg
Between 2-3 kg
Between 1.5-2 kg
Less than 1.5 kg
Between 2-3 kg
Don't know
46%

40. CHILD HEALTH
Figure 18. Length of time mother breastfed child
200
180
160
140
Number of mothers
120
100
80
60
40
20
0
Length of time mother breastfed (months)

41. CHILD HEALTH
Table 10. Location Where Child Received the Last Dose of Vitamin A
Location Number Percentage(%)
1 National Immunization Day 179 38.9
2 Other (include HC staff visit to village) 166 36.1
3 Sick child visit to Health Care Center 56 12.2
4 On routine visit to Health Care Center 50 10.9
5 Don’t know 9 2.0
Total 460 100

42. CHILD HEALTH
Figure 19. Illnesses the child suffered in the last 30 days
None/Healthy 0.0%
0.0% 0.0%
Child
0.0%
10.1%
Tuberculosis
0.1%
Malaria
0.1% Other
Encephalitis 7.9%
0.3% Chicken Pox Fever
0.4% 42.0%
Dengue Fever
0.8% Diarrhea
13.1%
Acute Respiratory
Infections
4.8%
Cough
20.5%

43. CHILD HEALTH
Table 11. Percentage of households reporting illness of child in last 30 day
CHILD ILLNESS % OF HOUSEHOLDS REPORTED CHILD ILL
FEVER 65.5
COUGH 32
DIARRHEA 20.4
DENGUE 1.2
MALARIA 0.2
ENCEPHALITIS 0.4
TUBERCULOSIS 0.2
ACUTE RESPIRATORY INFECTION 7.5
CHICKEN POX (VARICELLA) 0.6
OTHER 12.4
NONE/HEALTHY CHILD 15.7

44. CHILD HEALTH
Figure 20. Location where child received most vaccinations if
vaccinated.
Outreach activities
3%
Other (includes in
village)
34%
Health center
Has not been 62%
vaccinated
1% Private
practice/clinic
0%
National, provincial
or district hospital
0%
• 95.8% of mothers had a vaccination card for child at time of interview

45. CHILD HEALTH
Figure 21. Reasons for not vaccinating child
0
0 0 000
14.7% Too busy
2.9%
Unaware of benefits our vacination
29.4%
2.9%
Side affects
Place or timing for vaccination
11.8% unknown
Belief there is no need
Rumours
14.7% 23.5% Other

46. CHILD HEALTH
NUTRITION
Table 12. Food children received the day prior to the interview
% of children
Type of food
who received
Bread, rice, noodle or grain product 76.0%
Sugary foods 71.4%
Dark leaf green vegetables 67.3%
Porridge 67.2%
Eggs 48.5%
Commercially produced baby cereal 42.1%
Beef, pork, lamb, goat, rabbit 39.3%
Other fruits and vegetables 38.7%

47. CHILD HEALTH
NEEDS
 Child nutrition
 Children of factory workers are not exclusively breastfed 6M
 Preventative health
 Water safety
 Sanitary practices (latrine use, hand-washing, waste disposal)
 Disease causation

48. CHILD HEALTH
ASSETS
 Nancy TenBroek, CRWRC Regional Health Advisor
 Sponsorship schools raising awareness with nutrition program
 Government immunization program
 Save the Children Cambodia

49. PRIORITIES FOR HEALTH PROGRAMMING
 Safe Water Access
 Protection of water source
 Water treatment
 Increased understanding of water-borne diseases
 Sanitation
 Villages to achieve open defecation free status (ODF)
 Hand-washing practices
 Waste disposal
 Maternal and Child Nutrition
 Diversified diet containing necessary nutrients
 Preventative Health
 Disease causation
 Lifestyle
 Family planning

50. CONCLUSION
 Priorities fall under Primary Health Care
 Develop programming and network in areas of
priority
 Research further (possibly with PRA) what knowledge
and influences are behind the behaviors ie. Water
treatment
 Use data to apply for funding